Significant waits for children and young people with ASD and ADHD
There are significant wait times for large numbers of children and young people on the autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) diagnostic pathways.
Aspiration: The needs of children and young people related to ASD and ADHD are effectively identified at early stages, and there's high quality support before, during and after diagnosis.
1. Actions to ensure clarity about the support available
This will have a specific focus on autism on the local offer and providing details of all support available.
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3.1.1/2/3 collating details of all support currently available for those with (or possibly with) ASD and ADHD, across the age ranges.
3.1.4/5/6 ensure that an area is developed on the SEND local offer website specifically for ASD and ADHD. The support available to be promoted through newsletters and social media and through schools.
2. Actions to ensure good quality support for early years and educational settings
This will include a focus on understanding how inclusive all nursery, schools and colleges are and developing a training and support offer for staff.
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3.2.1 collecting feedback from educational settings regarding neurodiversity and how to support identified needs.
3.2.2 plans will be developed to meet the identified needs of schools and settings including outreach, training and coaching.
3.2.4/5 education settings to complete a self-evaluation of their admittance and inclusivity and their approach to enabling pupils to remain in mainstream education and thrive.
3. Actions to ensure good quality support for parents and carers
This will include ensuring the continuation of the Autism West Midlands offer to support families with or without a diagnosis and the Healthier Together website.
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3.3.1 continue the Autism West Midlands offer of support which does not require a diagnosis to access.
3.3.2 develop and launch the Child Development Centre (CDC) advice line which will be accessible to children for whom there are concerns, and help in navigating the system and what's available.
3.3.3 roll out of the Healthier Together website with advice and guidance for the neurodiverse population.
4. Actions to enable a trial of enhanced support
This will include the implementation of school-based neurodevelopmental practitioners and use of the Dimensions tool.
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3.4.1 develop and recruit to the roles of neurodiversity practitioners to support a targeted cohort.
3.4.2 review the impact of the neurodiversity practitioners to inform the requirements for support in the second year.
3.4.3 develop the Dimensions tool and seek clarity regarding how the tool will be used initially, and evaluated prior to further roll out.
Aspiration: children and young people who require a diagnostic assessment to easily access a high-quality diagnostic assessment in a timely way.
5. Actions to ensure referrers know how to make good referrals which are accepted
This will include the development and publishing of clear criteria for assessment on the local offer 0-25 years, and training for schools and others in responding to this criteria.
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3.5.1/2/3 ensure there is clear criteria and a referral route for current ASD diagnostic pathway in place, for all ages.
3.5.4 clear criteria and referral route for current ASD and ADHD pathway published on the local offer.
3.5.5 for the 5-18 service promote the 'Advice and Support Recommendations for Referrers’ document via SENCo and headteacher networks, primary care network, and SEND health operational group.
6. Actions to ensure communication from 5–18 diagnostic service is clear
This will include improving the quality of information shared with families and closer monitoring of families' experiences.
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3.6.1 review communications which are sent out with local SEND parent carer forums.
3.6.2 implement changes to improve communications and feedback to the SEND quality and assurance group to review the impact on children and young people/family experiences.
7. Actions to avoid children and young people going into crisis whilst waiting for diagnosis
This will include the implementation of a multi-service initial assessment of all referrals, prioritising referrals where school or home is at risk of breakdown, and clarity about how families can contact Bee-U if their situation changes.
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3.7.1 all referrals considered at a multi-disciplinary team discussion (including ASD practitioners, OT, nurses, social workers, psychiatry, ADHD specialists, psychology, cognitive hehavioural therapy).
3.7.2 upon acceptance of referral children and young people to be offered an initial holistic assessment which enables access to range of support available within Bee-U.
3.7.3 protocol in place for prioritising children and young people for ASD assessment based on factors such as whether their placement is at risk of breaking down.
3.7.4 further promotion of how families and children and young people can contact the service if their situation changes, so that their prioritisation can be reconsidered (currently stated in letter).
3.7.5 enhance the risk management approach through additional funding from the Learning Disability and Autism LDA programme.
3.7.6 complete an audit of cases waiting over six months to assess the impact of waiting, and review the effectiveness of approaches to manage risk. Share the learning from audits with the SEND Partnership Board and Learning Disability and Autism Board.
8. Actions to ensure capacity of the diagnostic service meets the demands of the population
This will include work to develop a more accurate understanding of the level of need, gaps in the current service and a business case to increase capacity.
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3.8.1/2/3 commissioner understanding of current waiting times from referral treatment for ASD for all ages.
3.8.4 develop, fund and recruit to short-term recovery plans.
3.8.5 understand the capacity of the services currently.
3.8.6 develop a trajectory of future growth and capacity required to meet the needs.
3.8.7 develop a business case to fund the increased demands across the age range.
3.8.8 services are reviewing their skill mix to mitigate the impact of challenges with recruitment and retention, in the context of increased demand.
3.8.9 Midlands Partnership Foundation Trust (MPFT) reviewing internal processes, progressing recruitment into one vacancy.
3.8.10 recruit to an enhanced Learning Disability and Autism Team structure.
9. Actions to monitor and escalate long waits to integrated care services (ICS)
This will include ensuring that there is a clear system for understand the level of risk around the waiting list and the impact this is has on families.
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3.9.1 clear data reporting of waiting list from providers with oversight from performance and assurance manager.
3.9.2 ensure the quality team have assurance in place around harm review and risk process.
3.9.3 dependant on level of harm as ascertained by harm review and risk process, ensure the potential risks of long waits are noted on the ICB risk registers.
What difference will these actions make and how will this be monitored?
Children, young people and their families report that they received support when they needed it, and they understand the support available. Practitioners can signpost effectively and report an improved understanding of autism, ADHD and other neurodevelopmental conditions. This will result in improved school attendance and a reduction in suspensions and exclusions. Waiting lists 0-25 will reduce to agreed average waiting times.
This will be monitored and evidenced via the development of a range of family surveys and feedback systems. Waiting lists will be closely monitored, and average wait times will be reduced to the levels detailed in the accelerated progress plan by the agreed dates.